Anticholinergic Drug Use on Admission and the Risk of In-Hospital Falls in Older Hospitalized Patients.

Purpose: In-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls. Patients and Methods: This retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium. Results: A total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional anticholinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06-2.10). Other measures, ie anticholinergic drug use (yes/no) and different categories of anticholinergic drug burden, measured with the ARS, ACB and list of Chew, were all not associated with in-hospital falls. Conclusion: Anticholinergic drug exposure on admission is possibly not a main risk factor for in-hospital falls among older patients.

Medical Students' Empathy Level Differences by Medical Year, Gender, and Specialty Interest in Akdeniz University.

BACKGROUND: As an important feature in patient-physician communication for both primary and clinical care, empathy is one of the basic competencies that physicians should possess. The primary aim of this study was to evaluate the level of empathy among medical students in all years of medical training using two different instruments: the Jefferson Scale of Physician Empathy (for clinical empathy level) and the Toronto Empathy Questionnaire (for general empathy level). MATERIALS AND METHODS: This study is a cross-sectional descriptive study conducted in 2017-2018 academic year with students studying at Akdeniz University Faculty of Medicine. Data collection form, Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) was applied to the students by the researchers. The statistical analysis was carried out by using IBM-SPSS version 23 for Mac OS. T-test, ANOVA test, Spearman and Pearson correlation analysis were used for comparisons. RESULTS: The mean TEQ score of the students was 52.8/65 and the JSPE-S score was 80.3/100. TEQ scores of students increased up to 4th year and then decreased, but the difference between the years was not statistically significant. The third year students' JSPE-S scores were significantly higher than that of the sixth year students. CONCLUSION: While the clinical empathy levels of medical students decreased significantly after 3rd year, the general empathy levels decreased less. This result shows us that we should review our medical education curriculum and educational environment, and should initiate initiatives, and devote more time to empathy education in order to prevent the decrease in empathy level and increase empathy during medical education.

Electrocardiographic Ccharacteristics of metastatic cardiac tumors presenting with ST-segment elevation.

INTRODUCTION: ST segment elevation (STE) in the standard 12­lead surface electrocardiography (ECG) is a well-known finding in patients with metastatic cardiac tumors. It is important to identify the specific characteristics of STE among those patients to prevent unnecessary aggressive treatments. In the present study, we aimed to demonstrate the ECG characteristics of patients with metastatic cardiac tumors who has STE. MATERIAL AND METHODS: Medical literature was searched from Pubmed database with key words "metastatic cardiac tumors" or "cardiac tumors" and "ST segment elevation" or "ST elevation". In addition, remaining articles were explored using the references of case reports which were obtained during former screening (snowball procedure). RESULTS: Thirty six of 46 case reports were included and ECG characteristics of each case were evaluated. Convex- shaped STE was observed in all patients and it showed a specific coronary territory in 35 of 36 patients (97.2%). Pathologic Q wave and/or loss of R wave progression were observed in only one patient. T wave inversion following STE was detected in 34 patients (94.4%). STE evolution was absent in 32 of 36 patients while the information regarding STE evolution were not provided in the remaining cases. CONCLUSION: STE due to tumor invasion has certain characteristics which could help clinicians in the differential diagnosis.

A successful catheter ablation of a ventricular fibrillation.

Malignant ventricular arrhythmias are challenging to manage, requiring a multidisciplinary approach. The mechanism, which triggers ventricular fibrillation (VF) associated with ventricular extrasystoles has not been clarified yet, however, abolishing ventricular extrasystoles may stop ventricular fibrillation in these patients. By this case presentation, we aimed to present a successful treatment of an electrical storm (ES), which developed after an acute myocardial infarction, by catheter ablation.

Difficult management of a patient presenting with recurrent syncope caused by diffuse vasospasm.

Spontaneous and simultaneous multivessel coronary artery spasm may present with multisite myocardial ischemia, atrioventricular block, acute lung edema, cardiogenic shock, or ventricular fibrillation. In a case of syncope caused by vasospasm, the underlying mechanism may be complex, such as atrioventricular block and/or ventricular arrhythmia. Dual implantable cardioverter defibrillator (ICD) placement should be considered along with optimal medical treatment. This report is a description of a 57-year-old male patient who was admitted to the hospital with chest pain followed by loss of consciousness. As the patient had bradycardia, a diffuse spasm, and life-threatening ventricular arrhythmia during ischemic episodes, a dual ICD device was implanted. ICD treatment may be a good option in cases with a diffuse spasm that is hard to control with medical treatment due to the risk of life-threatening ventricular arrhythmia.